Getting pregnant is a complicated business. The egg and sperm have to meet and fertilize and the resulting embryo has to grow and implant in the uterus. Most of this early part of conception takes place in the fallopian tubes. These thin tubes, around 8-10 cm long, stretch between the ovary and the uterus.

After ovulation, the egg is picked up by the open end of the fallopian tube which is close to the ovary, where it begins its journey towards the uterus. Millions of tiny hairs called cilia line the end and the inside of the tubes. These cilia beat hundreds of times a second and help to catch the egg and move it through the tube towards the uterus. The cells lining the fallopian tubes provide lubrication for the egg on its journey and nourishment for the sperm, egg, and developing embryo.

If sperm is present around the time of ovulation, the egg and sperm will meet in the second portion of the tube known as the ampulla. The egg and sperm combine to form the embryo, which starts its life as a single cell for the first 24 hours and will then continue its journey through the fallopian tube to the uterus.

Fallopian Tube Disorders

You can imagine that any serious dysfunction of the fallopian tubes will prevent conception, in which case in vitro fertilization (IVF), which bypasses the fallopian tubes, may be needed.

As well as acting as a transport system for the egg, sperm, and embryo, the tubes are the site of sperm capacitation and storage, fertilization, and early embryo development. The tubes are an important contributor to the nutrition and development of gametes and embryos. Any changes in the delicate cells lining the fallopian tubes can affect a woman’s ability to conceive.

In addition to being patent (open), the tubes must be healthy and disease-free to allow normal function. Identifying tubal occlusions, or blockages can be done using ultrasound or radiological imaging of the tubes after filling them with saline or a special dye. This investigation is usually done soon after you visit your doctor to discuss your fertility because the results will determine whether a couple should continue trying on their own or if they need surgery or the help of IVF.

HSG: Diagnosing Issues with Fallopian Tubes

A hysterosalpingogram (HSG) is a common test used to determine whether the fallopian tubes are patent (open) and if the uterine cavity is normal. During an HSG, a catheter is placed through the cervix into the uterus, and a contrasting dye is injected into the uterine cavity. Several X-rays are taken of the pelvic area to identify if the dye is traveling through the tubes, indicating that they are clear and whether there are any uterine abnormalities. An HSG is preferable to a sonohysterogram (which uses saline) because it provides more detailed information about the reproductive system, including the fallopian tubes. An HSG is part of the basic testing done in the early stages of diagnosis. It is performed between Days 5 and 11 of the menstrual cycle, and a woman can attempt conception in the same month.

This test is typically performed by a radiologist in the X-ray department of a hospital or clinic and usually takes 15 to 30 minutes. You may feel some cramping similar to menstrual cramps during the test and for a short time after.

Most women with blocked fallopian tubes do not have any symptoms. If only one tube is blocked, a woman can still get pregnant naturally, although usually only in the months when she ovulates on the side with the open tube. In rare cases, women have gotten pregnant when they ovulated on the side with the blocked tube, so it’s still worth trying every month if this is the case. It is also possible for a tube to be partially blocked, this increases the chances of an ectopic pregnancy, so it’s important to have a full investigation done if you are trying to conceive and have a history of pelvic infection.

What Causes Blocked Tubes?

The most frequent cause of blocked fallopian tubes is pelvic inflammatory disease (PID) which is usually the result of an infection. Salpingitis is the medical name given to enflamed fallopian tubes.

Here are some of the common causes of blocked fallopian tubes and their symptoms:

Salpingitis

This inflammation of the fallopian tubes is usually caused by a bacterial infection and is one of the most common causes of blocked fallopian tubes. Salpingitis is sometimes called pelvic inflammatory disease (PID), although PID can also refer to inflammation of other parts of the reproductive tract. Salpingitis may have no symptoms. In other cases, signs may include abnormal vaginal discharge, spotting between periods, painful periods, pain during ovulation or sex, and lower back pain.

Treatment options include prompt antibiotics when an infection is identified. Infection of one tube can easily lead to infection of the other tube because of their proximity.

Diagnosing salpingitis involves several tests, including:

• General examination: to check for localized tenderness and enlarged lymph glands
• Pelvic examination: to check for tenderness and discharge
• Blood tests: to check the white blood cell count and other factors that indicate infection
• Mucus swab: a test to identify the type of bacteria causing the infection
• Laparoscopy: a way to view the fallopian tubes with a slender instrument inserted through abdominal incisions

Sexually transmitted diseases, especially Chlamydia and Gonorrhea, can cause the tubes to become blocked. If you have a history of STDs and are having trouble conceiving, talk to your doctor about testing to see if your tubes are healthy. Uterine infections caused by pregnancy termination, surgery, or miscarriage can also lead to blocked tubes so make sure you mention any relevant history to your doctor.

Hydrosalpinx

A hydrosalpinx is a blocked fallopian tube filled with clear fluid; this is usually in response to an infection or other cause of PID such as endometriosis or surgery. Symptoms vary. Some patients have low, recurring abdominal pain or pelvic pain; others have no symptoms. Hydrosalpinges can be easily identified on an ultrasound by an experienced technologist. Treatment varies and can range from a simple course of antibiotics to complete removal of the affected tubes. Several studies of IVF pregnancies have shown lower success rates for women with hydrosalpinges in place compared to women with normal fallopian tubes. It is thought that the fluid leaks from the tube into the uterus and causes an adverse environment for embryo implantation. For this reason, it is advised to have affected tubes removed or remedied before fertility treatments and attempted conception.

Ectopic Pregnancy

An ectopic pregnancy occurs when an embryo implants and grows outside the uterus. This is usually in the fallopian tube but can be on the cervix, ovary, or in the abdomen. Ectopic pregnancy usually starts with a slow-rising, low level of hCG early in the pregnancy. This is a warning sign, and your doctor should monitor you carefully. Ectopic pregnancy is diagnosed through ultrasound and can be treated with drugs or, in severe cases, with surgery. If the embryo has implanted in the tube, it can cause serious complications if the pregnancy isn’t detected early. The tube could rupture, in which case surgery to remove the tube is necessary, which would compromise future fertility.

Endometriosis

Endometriosis is a condition where the cells lining the uterus (the endometrium) grow in places outside the uterus such as on the ovaries, fallopian tubes, outside surface of the uterus, bowel, bladder, or rectum, causing adhesions that can “glue” pelvic organs together. Because this tissue still responds to the same hormonal signals as the endometrial cells inside the uterus, the tissue breaks down and grows during the menstrual cycle, causing pain and inflammation before and after a woman’s period. The most common symptom of endometriosis is pelvic pain that gets worse just before the onset of menstruation (although some people with endometriosis won’t have any symptoms at all).

The cause of endometriosis isn’t known, but it’s believed that during menstruation, the menstrual tissue passes backward through the fallopian tubes and into the pelvis where it attaches and grows. Although endometriosis doesn’t always cause blocked tubes, adhesions can affect the position of the fallopian tubes and impede the flow of the egg down the tube. Endometriosis can also affect fertility by reducing egg quality or by producing an environment toxic to sperm and embryos. Treatment for endometriosis includes laser surgery that can reduce adhesions, hormone therapy, and complementary therapies.

What are the chances of conceiving with blocked fallopian tubes?

The chances of conceiving with blocked fallopian tubes depend on the cause of the blockage and the degree of damage present. If there is an infection, it should be treated and the tubes should be flushed to see if they can be unblocked without invasive surgery. Due to their delicate structure, it can be difficult to do surgical reconstruction on blocked fallopian tubes. So IVF is often required for conception if there is substantial damage and inflammation.

Infertility caused by pelvic adhesions can be reversed with surgery to remove the adhesions and return the anatomy to its natural place. As long as the tubes are healthy there should be a good chance of natural conception after adhesion removal.

Fallopian Tube Recanalization is a procedure where a catheter is used to inject liquid into the tube to try and flush out the blockage. The success of this procedure will depend on the cause of the blockage and the extent of the existing damage. Surgery can be done to reverse tubal ligation and other causes of blocked tubes but there is a risk that scar tissue may form and the tubes will not stay open long term. Your doctor should regularly check for tubal patency after reconstructive surgery to determine the chances of natural conception.

Sometimes the doctor will recommend the removal of the fallopian tubes before an IVF cycle to improve the chances of success, especially if there are hydrosalpinges present. Your best bet is to talk with a fertility specialist who can advise you on your best chance of success and your fastest path to getting pregnant.